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Health Care Safety Net Awareness Low Among Uninsured People

ASHINGTON, D.C.More than half of all uninsured Americans
are unaware of a community safety net provider where they can receive lower-cost,
affordable health care, according to a national study released today by the
Center for Studying Health System Change (HSC).

Many of the poorest and most disadvantaged uninsured people apparently do not
use or are unaware of the health care safety net, including 4.6 million uninsured
poor people, 5.7 million uninsured Latinos and 2.4 million uninsured African
Americans. Moreover, a striking number of uninsured peopleabout 7.9 millionare
unaware of a safety net provider despite living within 5 miles of a community
health center (CHC).

"The findings indicate that many uninsured people are unaware of an affordable
source of care to turn to when they need medical attention, putting them at
higher risk of going without medical attention," said Paul B. Ginsburg,
Ph.D., president of HSC, a nonpartisan policy research organization funded principally
by The Robert Wood Johnson Foundation.

Researchers asked uninsured people about their use and awareness of medical
care providers that offer lower-cost and affordable care. Uninsured people with
a usual source of medical care were asked, "At this place, do you pay full
price for medical care or do you pay a lower amount based on what you can afford
to pay?" In addition, uninsured people who did not pay a lower price at
their usual source of medical care or who did not have a usual source of care
were asked, "Thinking of the area where you live, is there a place that
offers affordable medical care for people without insurance?"

Taken together, responses to the two questions indicate that less than half
of the uninsured (48%)or about 18 million peopleuse or are aware of a safety
net provider in their community, according to HSCs Community Tracking Study
2003 Household Survey, a nationally representative survey involving information
on 46,600 people.

"Even if uninsured people dont have an immediate need for care, awareness
of a place to receive affordable care could encourage them to seek timely care
if the need arises, instead of waiting until their condition becomes more severe,"
said HSC Senior Health Researcher Peter J. Cunningham, Ph.D., who co-authored
the study with HSC Health Research Assistant Jessica H. May and HSC Senior Fellow
Jack Hadley, Ph.D.

Poor and lower-income uninsured peoplethose with incomes below 200 percent
of the federal poverty level, or $36,800 for a family of four in 2003were more
likely to know of a safety net provider in their community than uninsured people
with higher incomes. For example, 54 percent of uninsured people with incomes
below poverty were aware of a safety net provider compared with 43 percent of
uninsured people with incomes at or above 300 percent of poverty.

Awareness of a local safety net provider also was higher among uninsured racial
and ethnic minorities, likely in part because they tend to have lower average
incomes than uninsured whites. More than half of uninsured blacks (57%) and
Latinos (53%) knew of a safety net provider in their community, compared with
about four in 10 uninsured whites (41%).

Physician offices and clinics/health centers were identified as the most common
sources of lower-cost care. Of uninsured people who were aware of safety net
providers, 45 percent cited a clinic or health center as a safety net provider,
while about one-fourth (26%) identified a physician office.

Hospital outpatient clinics and emergency departments were much less likely
to be identified as safety net providers, although other HSC research has shown
that the uninsured receive more than half of their outpatient care from hospital-based
facilities. Only 8 percent of uninsured people who were aware of safety net
providers in their community identified a hospital emergency department as a
safety net provider.

"While uninsured people may be frequent emergency department users because
of a lack of alternativesand because by law they cant be turned awaythese
findings suggest that they dont necessarily regard ERs as places to receive
affordable or lower-cost care," Cunningham said.

Uninsured people living within 5 miles of a community health center
(CHC) are more likely to be aware of a safety net provider compared with uninsured
people who do not live near a CHC (53% vs. 43%).

Almost two-thirds (64%) of uninsured people identify a single place
where they usually go to receive medical care. However, less than half (45%)
of uninsured people with a usual source of care reported paying less than full
price for care. The uninsured are more likely to have a safety net provider
as their usual source of medical care if they are poor (55%), black (56%), Latino
(61%) and live closer to CHCs (54%). Additionally, uninsured people in poorer
health also are more likely to have a safety net provider as a usual source
of care.

Awareness of the safety net other than through a usual source of medical
care appears to be much more limited. For uninsured people without a safety
net provider as a usual source of care, less than one-third (29%) were aware
of safety net providers in their community

### ###

The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nations
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is funded principally by
The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy
Research, Inc.